What Is Sciatica? Symptoms and Causes

Sciatica is a somewhat misunderstood condition. Many people refer to any radiating pain in the back and legs as “sciatica.” In reality, sciatica only refers to pain that stems from pressure or irritation on the sciatic nerve.

Sciatica’s main symptom is pain that starts in the lower back, radiates into the buttocks, and then runs down the back of one leg into the foot, following the path of the affected sciatic nerve. Often, the leg pain will be worse than the back pain. If this pain is from LDH, it’s important to rule out a serious medical condition called cauda equina syndrome where you lose bladder or bowel control.

Here are some other symptoms that often indicate sciatica, including the following:

• Muscle spasms in the back
• “Pins and needles” sensations in the leg and/or foot
• Numbness in the leg and/or foot
• Shooting or burning pain deep in the buttocks or legs
• Weakness in the affected leg

Sciatica occurs when the sciatic nerve is pinched, compressed, or irritated in some way. Here are some possible mechanisms.

1. LDH: Lumbar spine Disc Herniation. This occurs more for people 30-60 years old. Your spinal vertebrae are cushioned and protected by flexible cartilage discs (spinal discs). If one of these discs bulges or ruptures so that it irritates or pinches the sciatic nerve, you’ll experience sciatica pain.
2. Degenerative Disc Disease (DDD). This tends to happen for those over 60 years old. Your disc that cushions your vertebrae gets dehydrated as you age. That decreases the size of the disc and cushioning, which decreases the size of the hole that the sciatic nerve travels through to cause the pinching. It’s possible to have a combination of LDH and DDD.
3. Bone spurs. This happens due to arthritic changes that happen with DDD. The excessive bone growth can irritate the sciatic nerve if the spur is in the way of where the nerve travels.

The next three mechanisms can irritate the sciatic nerve but are more related to the pelvis.

4. Pelvic instability, SI Joint Dysfunction. This tends to be related to hormonal changes during menstrual cycles, during pregnancy, and postpartum especially if breastfeeding. The hormones can create laxity in the ligaments and joints that can cause mechanical changes to irritate the sciatic nerve. Our therapists would be able to help you distinguish if your symptoms are coming from the pelvis, LDH, or DDD.
5. Leg Length Discrepancy. A longer leg can create uneven excessive pressure to cause mechanical changes to irritate the sciatic nerve. Our therapist would be able to help you determine if the leg length discrepancy is from an unstable pelvis or if one leg is truly longer than the other.
6. The ultimate reason or cause of LDH is our body getting stiff and losing its ability to rotate from the upper back (thoracic spine) and hips (pelvis). These areas are designed to rotate, but if the muscles in these areas get shortened and weak, and lose its ability to rotate, it will make the lumbar spine that’s located between the two structures to excessively twist and damage and herniate the lumbar spinal discs.

These different mechanisms of injury can seem complicated, but our physical therapists can help answer questions and make a custom treatment plan to help decrease pain immediately.

How Physical Therapy Can Help With Sciatic Pain

When treating a lumbar spine herniated disc (and, by extension, sciatica), our therapists will move through the following steps:

• Manage Pain: We’ll develop a plan to address your acute pain, pulling from several options. We may initially avoid the lumbar spine “hot spots” and work on hip mobilizations and hip soft tissue manipulation; this is an effective way to release stress on the lower back to decrease pain. We can also utilize pain relieving modalities such as Class IV lasers, TENS or hot, cold therapy, and acupuncture can all help.
• Improve Mobility: Disc herniations typically occur due to excessive stress between lumbar vertebrae of L4-5 or L5-S1, we will mobilize joints above and below the disc herniation to redistribute and normalize the mechanical stress on your spine. Fascial releases and soft tissue work to calm spasms will increase mobility which is incredibly effective to decrease pain. We will even check your ankle mobility to make sure that your body can be supple and have an accordion or coiling effect to maximize shock absorption during gravity dependent activities.
• Integrate Movement: Movement is crucial in addressing sciatica. We focus on a strategy of pain-free movement patterns to help your spasmed muscles to relax. This allows you to move better without putting excessive mechanical stress on the impacted vertebrae and LDH. We’ll also incorporate dynamic stretches and mobility work to increase circulation to facilitate faster healing.
• Strengthen Your “Core”: If you read our September Newsletter, it explains how we approach “core strength” more holistically.  We get better results when we integrate your abdominal muscles with the muscles of your upper back and hip muscles. The goal is to both support your spine, but also take mechanical stress off your spine. This is done by integrating and strengthening your trunk and hip muscles to alleviate the pressure on your lumbar spine that is causing sciatic pain and a herniated disc.
• Educate to Prevent Future Pain: Finally, we can provide the tools to prevent a future bout of sciatica. We might help you develop a home exercise program to keep your spine healthy or show you how to properly lift heavy objects to avoid injury.